► The WHO released an articletitled Human infections with avian influenza A(H7N9) virus in China: preliminary assessment of the age and sex distribution.

● The article examines the cases reported from 31st of March – 16th of April 2013 and concludes that the median age of cases was 64 years (range four-78) and that 71% of cases were males. These distributions differ both from China’s overall demography and from the avian influenza A(H5N1) cases reported fromChina. The majority of avian influenza A (H5N1) cases have been in workingadults and no significant difference in gender have been identified.

► The World Organization on Animal Health has reported six additional cases in birds since the April 15 information sharing report, including from farm and live bird markets. Preparedness and Response Activities

Provincial Level

► Teleconferences were held today with public health units and with health liaison organizations (LHINs, associations, unions and colleges) to share updates and answer questions.

► The Ministry of Health and Long-Term Care’s (MOHLTC’s) Emergency Operations Centre remains activated to support processes for information sharing and monitoring among provincial, federal and local health system partners as well as with other operations centres.► The MOHLTC is maintaining online information for health sector partners at www.ontario.ca/avianinfluenza. Health sector partners with online information are encouraged to link to this site.

► The MOHLTC continues to monitor information and liaise with Public Health Agency of Canada (PHAC), Public Health Ontario, Ministry of Agriculture and Food, the Ministry of Labour and the Ministry of Community Safety and Correctional Services to monitor the evolving situation and to coordinate next steps.Federal Level► PHAC’s Health Portfolio Operations Centre (HPOC) remains at “Increased Vigilance and Readiness”.Next Steps► The MOHLTC continues to work with its partners to develop contingency plans in the event that the risk posed by avian influenza A (H7N9) increases.► Teleconferences will be scheduled for April 29th with health liaison organizations (LHINs, associations, unions and colleges) to share updates and answer questions. Additional teleconferences with public health units will be held upon request or if there are any significant epidemiological changes in this event.

The next information sharing report will be issued on Monday (April 29, 2013) at 1500hto share new information.

► On April 1st 2013, the World Health Organization (WHO) notified Member States that eleven human cases of influenza A (H7N9) had been confirmed. All of these cases were identified in China.

► There is heightened awareness of this situation by public health officials around the world given that this virus had not previously been found in humans, the mode of transmission has not yet been confirmed, and the virus is able to cause severe morbidity and mortality in humans.

► To date, the WHO has announced a total of 60 cases of infection with influenza A (H7N9), and 13 deaths, all in China.● Over one thousand close contacts of the confirmed cases are being closely monitored.

● The WHO states that while two confirmed cases have been associated with possible family clusters, and limited human-to-human transmission may occur where there is close contact between cases and other individuals, there have been no confirmed instances of ongoing human-to-human transmission.► Influenza A H7 viruses are a group of influenza viruses that normally circulate among birds. The influenza A(H7N9) virus is one subgroup among the larger group of H7 viruses.

► The World Organisation for Animal Health (OIE) has confirmed that A(H7N9) samples have been found in multiple bird species and environmental samples in Shanghai and neighbouring markets. ● International media are reporting that Chinese authorities are culling poultry in some of the affected areas and have suspended the trade of live poultry. ► According to the WHO, laboratory testing in China has shown that the virus is sensitive to antiviral medications oseltamavir and zanamavir. However, at this time, there are no reports of the use of these drugs for the treatment of influenza A(H7N9) infection.● Ontario has a stockpile of these medications for use during an influenza pandemic.► The Public Health Agency of Canada (PHAC) has advised that the risk to Canadians associated with avian influenza in birds is generally very low.

Preparedness and Response Activities

Provincial Level► On April 5, 2013, the MOHLTC posted a health bulletin on the ministry’s website to share information about this event with the public.

► On April 12, the MOHLTC activated its Emergency Operations Centre in order to facilitate information sharing and monitoring with other governments and the health care system.► On April 12, 2013, the Chief Medical Officer of Health sent a memo to local Medical Officers of Health, as well as to health system partners to share information about this event. This communication includes recommendations about appropriate Infection Prevention and Control and Occupational Health and Safety (IPAC&OHS) measures. This information will be posted on the Ministry of Health website.

● Partners were encouraged to share information about this event and MOHLTC recommendations about Occupational Health and Safety with their local health system partners and memberships and also to refer calls to the ministry’s Healthcare Provider Hotline (1-866-212-2272). ● Health providers have been asked to call Public Health Ontario Laboratory (PHOL) Customer service at 416-235-6556 or 1-877-604-4567 if submitting respiratory specimens for viral testing on patients who became ill in China or within 10 days of return to Canada, or any direct contacts who also have acute respiratory illness.► On April 15, 2013, the MOHLTC held teleconferences with public health units and other health system partners to provide updates on the situation in China and Ontario’s monitoring and information sharing.► The MOHLTC continues to liaise with PHAC, Public Health Ontario, the Ministry of Agriculture and Food, the Ministry of Labour and the Ministry of Community Safety and Correctional Services to monitor the evolving situation and coordinate next steps, including contingency planning.Federal Level

► On April 6, 2013, PHAC posted a Level 2 travel health notice for Canadians planning travel to China. The advisory provides suggestions for how individuals can reduce their risk, such as practising hand hygiene and cough etiquette.

► On April 10, PHAC released an assessment of public health risk for Canada, which stated that the risk is low. ► On April 12, 2013, The Public Health Agency of Canada (PHAC) updated its public health notice.► PHAC’s National Microbiology Laboratory (NML) has access to the H7N9 whole genome sequence through the Global Initiative on Sharing Avian Influenza Data. This information provides the NML with the capability to rapidly detect the H7N9 virus. ● The NML is working closely with the provincial laboratories, including the PHOL, to update provincial testing capabilities for the influenza A(H7N9) virus.

► PHAC has created a web page to share information with the public and health professionals. WHO Level

This document shares epidemiological information, as well as information about clinical presentations, virology and treatment. It also summarizes WHO actions and recommendations.

Next Steps

► The MOHLTC continues to work with its partners to develop contingency plans in the event that the risk posed by influenza A(H7N9) increases.

► Health system partners and health providers who have questions related to influenza A (H7N9) are encouraged to contact the ministry at 1-866-212-2272.

► The next external information sharing report will be issued weekly or if there is a significant update.► Public health unit and other health sector partner teleconferences will be held next Monday, April 22nd, 2013.